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July 11th, 2016:

With return of Big Tobacco to Myanmar, smoking rates on the rise

Jul 11th, 2016
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Since the return of Big Tobacco to Myanmar en masse in 2013, smoking rates have increased markedly. Tobacco control experts warn that the firms’ sophisticated strategies are likely to push more people into the clutches of addiction.

http://sea-globe.com/myanmar-big-tobacco/

From the backseat of a traffic-stranded cab attempting to travel from Yangon’s airport to a city hotel, Myanmar’s burgeoning love affair with cigarettes quickly starts coming into focus.

Vendors peer into car windows, peddling cigarettes. Calling one over, the cab driver buys two individual filter tips and lights up, eagerly espousing the low cost of his favourite brand, Red Ruby.

In the city’s central downtown area, kiosks selling everything from a single brand to a staggering array of tobacco products are situated on nearly every street corner. And the smokers aren’t far behind. Cigarette vendor Sein Win, 46, is adamant that more people have taken up the habit in recent years, although this has not translated into an increase in customers – he blames the sheer number of salespeople trying to ride the boom. “My sales rate is lower than before because there are new vendors opening,” he said.

While many in the country have traditionally preferred chewing betelnut or smoking cheroots – local cigars that turn popular teashops into a haze of smoke as customers puff away with aplomb – Myanmar is currently seeing a rapid increase in the popularity of manufactured cigarettes as political change swings open the country’s doors to investment.

Tobacco firms were among the first global brands to descend upon Myanmar in 2013 after its quasi-civilian government began implementing reforms. Japan Tobacco International (JTI), British American Tobacco (BAT) and the state-owned China Tobacco now all have a presence there.

It’s little wonder. According to the WHO, 45% of adult males and 8% of women used some form of tobacco each day in Myanmar in 2012, although just a tiny fraction – an estimated 4% – smoked cigarettes, meaning that a large potential market was ripe for the taking. Meanwhile, in 2013, market research firm Euromonitor identified Myanmar as one of the top 20 potential markets for consumer goods companies globally, on account of increased investment along with population growth – and named tobacco as one of the seven key industries in the nation of about 55 million people.

According to Than Sein, the president of People’s Health Foundation in Myanmar, there are now 62 brands of cigarettes clamouring for a share of the country’s tobacco market, compared to the 10 or 15 brands that were available in the 1990s.

Judith Mackay, a senior advisor at Vital Strategies who has been a leading advocate for tobacco control for 30 years, said that as smoking rates have fallen in developed countries, Big Tobacco has turned its attentions to new horizons.
“They really tend to go all out to get any smokers they can,” she said. “The low- and middle-income countries are particular targets.”

“Typically, these markets have high smoking rates and, in many cases, are trying to attract investment,” added Ross Mackenzie, a public health expert at Macquarie University in Sydney. “Transnational tobacco corporations take advantage of globalised production and distribution networks and economies of scale to promote their brands.”

BAT, which had a joint venture with a military-owned company until leaving Myanmar in 2003 following a concerted campaign by overseas human rights activists, has invested $50m to build its factory on the outskirts of Yangon to begin producing its London brand of cigarettes – the top-selling brand before Red Ruby took its mantle in the intervening years.

“THE FOREIGN TOBACCO COMPANIES BRING IN VERY SOPHISTICATED ADVERTISING, PROMOTION AND SPONSORSHIP THAT THE [LOCAL] MONOPOLIES DON’T HAVE”

The return of BAT, and establishment of others, is “highly significant” in terms of changing cigarette consumption habits, according to Mackay, who said these transnational tobacco companies were on a different level to government-affiliated firms and monopolies. “The foreign tobacco companies bring in a new scenario of very sophisticated advertising, promotion and sponsorship, which in general the monopolies don’t have; they bring with them much more sophisticated obstruction to legislation.”

According to May Myat Cho, the Myanmar country coordinator for the Southeast Asia Tobacco Control Alliance (SEATCA), official sentinel surveys clearly show that male smoking rates dipped from a peak of 48.6% in 2003, the year BAT left Myanmar, before climbing to 46.8% when the firm returned in 2013 and increasing sharply to 60.3% last year.

Similarly, the surveys showed female smoking rates were at 13.7% in 2003, but this had increased to 18% in 2015.

Women and young people, in particular, are in the crosshairs for tobacco firms. Vendor Sein Win said most of his customers are aged between 15 and 20, but his youngest is just ten years old. “There is no age limitation for selling cigarettes here. If an underage person comes and asks to buy cigarettes, we have to sell to them. We don’t want any problems.”

He is mistaken: Myanmar banned the sale of tobacco to minors aged under 18 in 2006, when the government introduced a tobacco control law that also prohibits all forms of tobacco advertising, the sale of individual cigarettes and requires health warnings be printed on tobacco products.

However, according to experts, Big Tobacco is using myriad tactics to circumvent this legislation, which, despite government efforts, is not being implemented by authorities on the ground. “They take advantage of limited and/or poorly [enforced] tobacco control regulations in aggressive marketing campaigns that include some combination of traditional advertising and sponsorship of sports, music and cultural events, which can also lead to access to policymakers,” MacKenzie said of the firms’ strategies globally.

In a recent interview with Frontier Myanmar magazine, BAT Myanmar managing director Rehan Baig denied that his company was using advertising in the country.

SEATCA’s Myat Cho disputed this, saying that as well as selling and distributing cigarettes at teashops and restaurants, “they are also distributing complimentary napkins, ashtrays and lighters at teashops, and actually with the brands [visible]”. She added that cigarette kiosks often display promotion posters and some companies, she cited JTI in particular, were known to distribute free cigarettes at major religious festivals – both practices that are outlawed.

One of the more insidious, less-well-known avenues used by Big Tobacco to influence government policy is via the International Tax and Investment Centre (ITIC), which Mackay described as a “front organisation” for the alcohol, tobacco, oil and food industries that sets up secretive meetings with government officials worldwide to pressure them into keeping taxes low. She added that there is plenty of evidence the organisation is active in Myanmar.

“They have their meetings in the House of Lords in London; they’re a very, very powerful group of retired finance ministers and customs officials, and they’re using other front organisations and challenging governments. And when they get into a country, particularly, it seems to get even worse,” she said. “What they do is, they work with the ministry of finance, so the health people often… have no knowledge of them,” she added.

Despite this, Myat Cho is optimistic that the country’s new health minister, Myint Htwe, a former director of the non-communicable diseases department at the WHO’s regional office, will draw upon his experience to tackle tobacco use in Myanmar. Last year, the government increased taxes on tobacco products from 50% to 60%, and pictorial health warnings – shown to be effective in deterring smokers in other countries – are due to be introduced in September.

“The tobacco industry already wrote letters to the Ministry of Health to delay the implementation, so we’re expecting those challenges, but we’re working closely with the ministry and providing our assistance [with] whatever they need, so I think it will be effective,” she said. “And also the taxes on tobacco changed from ex-factory price to retail price, so the revenue will be increased, but whether it will be immediately effective on the reduction of smoking – they need to increase the tax higher.”

Regardless, in-country production, which makes cigarettes much cheaper and more accessible than foreign imports, is ramping up. At the height of military rule in the 1990s, approximately 500m sticks were produced in the country annually, according to official government statistics provided by SEATCA. This jumped to 3 billion by 2005, and it is estimated that 5 billion were manufactured last year. An increasing tide of production is difficult to stem, especially while the novice government has serious political, economic and social challenges it must now manage.

“The difficulty is that tobacco tends to be a rather low priority” in comparison to other issues, said Mackay. “The other difficulty is that, up to now, countries like Myanmar have been fighting infectious diseases such as TB, malaria and maternal mortality and infant mortality. They have no or very little experience dealing with the sophisticated tobacco companies; it’s a different paradigm, dealing with a vector that is not a mosquito, that is not a bacteria.”

The upshot, she added, is that a growing number of people in Myanmar are likely to take up cigarettes or swap their traditional tobacco for manufactured filter tips. “We’re certainly not talking within a year or two, but I would suspect if you were to review this in ten years’ time, you certainly might find a shift in the cigarettes people are smoking, particularly the young, and particularly the better educated; that would be the pattern.”

University student Kaung Htet Lin, 16, started smoking about a year ago amid peer pressure. Now, he struggles to kick the habit. “I want to quit, but I can’t because if someone smokes in front of me, I want to smoke and inhale too,” he said.

And in his changing preferences – from a local brand to one owned by tobacco giant BAT – could lie an early glimpse of the future: “Mostly I smoked Red Ruby; now I’m smoking Lucky Strike.”

Smoke gets in your eyes

The long, strange history of global tobacco use

Some smoke it, some chew it, others curse it. Regardless of its toxic health effects, tobacco has been a global pastime for centuries. Its origins are in the Americas, where the World Health Organisation (WHO) claims cultivation of the plant began as early as 6,000 BCE. Within 150 years of European settlers arriving to the ‘New World’, the tobacco plant was being used around the globe.

While in past centuries snuff and cigars were among the more popular methods of enjoying tobacco, the early 1900s ushered in mass cigarette production, and the modern cigarette was born in 1913 with R.J. Reynolds’ Camel brand. Smoking subsequently grew in popularity throughout the 20th century.

In 1951, however, the first large-scale study of the relationship between smoking and lung cancer was produced, followed by mounting evidence of the associated health risks. Smoking rates in industrial countries have dropped off significantly over the past 60 years, but tobacco use in the developing world remains a major health concern.

The WHO predicts that tobacco use will cause 8.4 million deaths annually by 2020, 70% of which will occur in developing countries.

Uruguay Defeats Philip Morris In Major Win For Anti- Smoking Advocates

Jul 11th, 2016
by Editor.
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Uruguay has defeated Philip Morris, the global tobacco giant, in a major international lawsuit over the country’s tough anti-smoking regulations. The Swiss-based company sued Uruguay at the World Bank’s International Center for Settlement of Investment Disputes under the terms of a 1991 bilateral investment treaty between Uruguay and Switzerland.

Philip Morris, which was founded in London in 1847, is now the world’s largest cigarette manufacturer with annual revenues of over $80 billion. It has been waging an aggressive battle around the world against national laws requiring tobacco companies to print graphic warnings about the health impacts of smoking. So far it has lost  lawsuits in courts in Australia, Norway, Thailand and the UK.

On March 26, 2010, Philip Morris filed a complaint against Uruguay at the World Bank arbitration tribunal. The action was intended to escalate the fight to an international level and to take advantage of trade agreements that typically favor major corporations by allowing them to claim damages from laws that deny them profits from their investments.

“This is like David and Goliath,” Silvina Echarte Acevedo, the legal adviser in charge of the Uruguayan ministry of public health’s case, told the Independent newspaper.

“They are bullying us because we are small.”

In suing the small South American country, Philip Morris also hoped to strike down some of the toughest anti-smoking laws in the world. Uruguay requires tobacco companies to print health warnings and graphic images such as diseased lungs and rotting teeth that cover 80 per cent of both sides of cigarette packets. It also requires companies to use the same image for all its products making it hard for the company to promote sub-brands like lights or mild cigarettes. Taxes have been hiked and smoking in public places have been banned.

On October 13, 2014, Paul Reichler, a lawyer with Foley Hoag, in Washington DC, responded on behalf of the Uruguayan government, citing the country’s obligations under the World Health Organisation’s 2005 Framework Convention on Tobacco Control.

The case was heard by a three person panel under arbitration rules that allow each party to appoint a judge each and mutually agree on a third. Not surprisingly when the verdict was delivered on July 8, 2016, Piero Bernadini, appointed by Uruguay, sided with the country, while Gary Born, apppointed by Philip Morris, sided with the company. The deadlock was broken by James Crawford, an Australian judge appointed by the World Bank, who sided with Uruguay.

“It is not acceptable to prioritize commercial considerations over the fundamental right to health and life,” Uruguay’s President Tabaré Vázquez announced in a victory speech to his citizens. “The health measures that we have imposed to control tobacco and protect the health of our people have been recognized as legitimate and adopted as a sovereign function of our republic.”

Other politicians and anti-smoking advocates applauded the verdict, notably Michael Bloomberg, the billionaire former mayor of New York city who helped fund Uruguay’s
defense.

“This is a major victory for the people of Uruguay — and it shows countries everywhere that they can stand up to tobacco companies and win,” Bloomberg said. “No country
should ever be intimidated by the threat of a tobacco company lawsuit, and this case will help embolden more nations to take actions that will save lives.”

The company attempted to put its best face forward. “We’ve never questioned Uruguay’s authority to protect public health,” Marc Firestone, general counsel at Philip Morris. “The arbitration concerned an important, but unusual, set of facts that called for clarification under international law, which the parties have now received. For the last seven years, we have already been complying with the regulations at issue in the case, so today’s outcome doesn’t change the status quo.”

However the company’s previous statements make it clear that this is a significant defeat.

“The large size of these warnings prevents us from effectively displaying our trademarks and goes beyond what could reasonably be considered appropriate to inform consumers of the well-established health risks of smoking,” Morgan Rees, a spokesperson for Philip Morris, told Investment Arbirtation Reporter. “This is without precedent anywhere in the world.”

Teen vaping could reverse progress in the control of tobacco

Jul 11th, 2016
by Editor.
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Nicotine experimentation could become nicotine addiction for youth who never used any other tobacco products, USC study suggests

http://www.eurekalert.org/pub_releases/2016-07/uosc-tvc070516.php

A new USC study debunks the popular belief that electronic cigarettes are merely a substitute for cigarettes among teens. Instead, the study suggests that some teens who never would have smoked cigarettes are now vaping.

E-cigarettes, which entered the U.S. market in 2007, vaporize liquids that may or may not contain nicotine. In 2011, about 1.5 percent of high schoolers had vaped in the past 30 days, according to the National Youth Tobacco Survey. Four years later, that number skyrocketed to 16 percent.

A USC study of 5,490 high school juniors and seniors shows tobacco use among teens in Southern California is on the rise.

In 2014, about 14 percent of 12th-graders said they had either smoked or vaped in the previous 30 days. A decade earlier — before e-cigarettes were sold in the United States — 9 percent of surveyed teens in this age group reported that they had smoked, said Jessica Barrington-Trimis, lead author and a postdoctoral scholar research associate in the Department of Preventive Medicine at the Keck School of Medicine of USC.

“If teenagers who vape are using e-cigarettes instead of cigarettes, we would have expected to see the decline in smoking rates continue through 2014,” Barrington-Trimis said. “But what we’ve seen is a downward trend in cigarette use from 1995 to 2004 but no further decrease in cigarette smoking rates in 2014. The combined e-cigarette and cigarette use in 2014 far exceeded what we would have expected if teens were simply substituting cigarettes with e-cigarettes. The data suggest that at least some of the teens who are vaping would not have smoked cigarettes.”

The study, published on July 11 in the journal Pediatrics, followed five groups of high schoolers who graduated in 1995, 1998, 2001, 2004 and 2014. Researchers collected the history of tobacco use in an individually administered questionnaire.

Cigarette use is the largest preventable cause of death and disease in the United States. Cigarette smoking kills more than 480,000 Americans annually, according to the Centers for Disease Control.

“An important question in the rapidly evolving landscape of youth tobacco product use is whether e-cigarettes are replacing cigarettes,” said Rob McConnell, the study’s senior author and professor of preventive medicine at Keck Medicine of USC. “However, use of e-cigarettes by youth who would not otherwise have smoked results in exposure to the hazards of inhaled vaporized liquids and flavorings in e-cigarettes and may result in exposure to nicotine that can damage the adolescent brain.”

USC is one of 14 U.S. research institutions that received National Institutes of Health funding to establish the Tobacco Centers of Regulatory Science.

What the numbers suggest

The National Youth Tobacco Survey has reported a long-term decline in teen smoking rates followed by a leveling off between 2014 and 2015.

The USC study found that the number of 12th-graders in Southern California who had smoked in the past 30 days dropped from 19 percent in 1995 to about 9 percent in 2004 and then leveled off, with the rate of smoking just under 8 percent in 2014.

But when cigarettes and e-cigarettes were combined, some 14 percent of high school seniors in 2014 said they had smoked or vaped in the last 30 days.

“Because e-cigarettes are perceived as less harmful and less dangerous than combustible cigarettes, another concern is that teens may be introduced to nicotine use via e-cigarettes,” Barrington-Trimis said. “In California, where smoking rates are among the lowest in the country, the increase in vaping, possibly followed by increases in smoking, could erode the progress that has been made over the last several decades in tobacco control.”

A perilous experiment

In fact, older teens who experiment with electronic cigarettes are six times more likely to try regular cigarettes within about a year when compared to those who have never vaped, reported Barrington-Trimis and her USC colleagues in a study published last month in Pediatrics.

Although some e-liquid providers say their products do not contain nicotine, this industry has not been regulated until just recently. The U.S. Food and Drug Administration announced plans to regulate all tobacco products — including e-cigarettes, cigars and hookah tobacco — in May. Last month, California became the second state, behind Hawaii, to raise the age of tobacco purchase — including e-cigarettes — from 18 to 21.

“E-cigarettes may be recruiting a new group of kids to tobacco use,” Barrington-Trimis said. “E-cigarettes may be safer than regular cigarettes for adults who are transitioning from smoking to vaping, but for youth who have never used any other tobacco products, nicotine experimentation could become nicotine addiction.”

###

The study was supported by the National Institutes of Health National Cancer Institute and the Food and Drug Administration Center for Tobacco Products (P50CA180905).

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

With return of Big Tobacco to Myanmar, smoking rates on the rise

Jul 11th, 2016
by Editor.
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Since the return of Big Tobacco to Myanmar en masse in 2013, smoking rates have increased markedly. Tobacco control experts warn that the firms’ sophisticated strategies are likely to push more people into the clutches of addiction

http://sea-globe.com/myanmar-big-tobacco/

From the backseat of a traffic-stranded cab attempting to travel from Yangon’s airport to a city hotel, Myanmar’s burgeoning love affair with cigarettes quickly starts coming into focus.

Vendors peer into car windows, peddling cigarettes. Calling one over, the cab driver buys two individual filter tips and lights up, eagerly espousing the low cost of his favourite brand, Red Ruby.

In the city’s central downtown area, kiosks selling everything from a single brand to a staggering array of tobacco products are situated on nearly every street corner. And the smokers aren’t far behind. Cigarette vendor Sein Win, 46, is adamant that more people have taken up the habit in recent years, although this has not translated into an increase in customers – he blames the sheer number of salespeople trying to ride the boom. “My sales rate is lower than before because there are new vendors opening,” he said.

While many in the country have traditionally preferred chewing betelnut or smoking cheroots – local cigars that turn popular teashops into a haze of smoke as customers puff away with aplomb – Myanmar is currently seeing a rapid increase in the popularity of manufactured cigarettes as political change swings open the country’s doors to investment.

Tobacco firms were among the first global brands to descend upon Myanmar in 2013 after its quasi-civilian government began implementing reforms. Japan Tobacco International (JTI), British American Tobacco (BAT) and the state-owned China Tobacco now all have a presence there.

It’s little wonder. According to the WHO, 45% of adult males and 8% of women used some form of tobacco each day in Myanmar in 2012, although just a tiny fraction – an estimated 4% – smoked cigarettes, meaning that a large potential market was ripe for the taking. Meanwhile, in 2013, market research firm Euromonitor identified Myanmar as one of the top 20 potential markets for consumer goods companies globally, on account of increased investment along with population growth – and named tobacco as one of the seven key industries in the nation of about 55 million people.

According to Than Sein, the president of People’s Health Foundation in Myanmar, there are now 62 brands of cigarettes clamouring for a share of the country’s tobacco market, compared to the 10 or 15 brands that were available in the 1990s.

Judith Mackay, a senior advisor at Vital Strategies who has been a leading advocate for tobacco control for 30 years, said that as smoking rates have fallen in developed countries, Big Tobacco has turned its attentions to new horizons. “They really tend to go all out to get any smokers they can,” she said. “The low- and middle-income countries are particular targets.”

“Typically, these markets have high smoking rates and, in many cases, are trying to attract investment,” added Ross Mackenzie, a public health expert at Macquarie University in Sydney. “Transnational tobacco corporations take advantage of globalised production and distribution networks and economies of scale to promote their brands.”

BAT, which had a joint venture with a military-owned company until leaving Myanmar in 2003 following a concerted campaign by overseas human rights activists, has invested $50m to build its factory on the outskirts of Yangon to begin producing its London brand of cigarettes – the top-selling brand before Red Ruby took its mantle in the intervening years.

“The foreign tobacco companies bring in very sophisticated advertising, promotion and sponsorship that the [local] monopolies don’t have”

The return of BAT, and establishment of others, is “highly significant” in terms of changing cigarette consumption habits, according to Mackay, who said these transnational tobacco companies were on a different level to government-affiliated firms and monopolies. “The foreign tobacco companies bring in a new scenario of very sophisticated advertising, promotion and sponsorship, which in general the monopolies don’t have; they bring with them much more sophisticated obstruction to legislation.”

According to May Myat Cho, the Myanmar country coordinator for the Southeast Asia Tobacco Control Alliance (SEATCA), official sentinel surveys clearly show that male smoking rates dipped from a peak of 48.6% in 2003, the year BAT left Myanmar, before climbing to 46.8% when the firm returned in 2013 and increasing sharply to 60.3% last year.

Similarly, the surveys showed female smoking rates were at 13.7% in 2003, but this had increased to 18% in 2015.

Women and young people, in particular, are in the crosshairs for tobacco firms. Vendor Sein Win said most of his customers are aged between 15 and 20, but his youngest is just ten years old. “There is no age limitation for selling cigarettes here. If an underage person comes and asks to buy cigarettes, we have to sell to them. We don’t want any problems.”

He is mistaken: Myanmar banned the sale of tobacco to minors aged under 18 in 2006, when the government introduced a tobacco control law that also prohibits all forms of tobacco advertising, the sale of individual cigarettes and requires health warnings be printed on tobacco products.

However, according to experts, Big Tobacco is using myriad tactics to circumvent this legislation, which, despite government efforts, is not being implemented by authorities on the ground. “They take advantage of limited and/or poorly [enforced] tobacco control regulations in aggressive marketing campaigns that include some combination of traditional advertising and sponsorship of sports, music and cultural events, which can also lead to access to policymakers,” MacKenzie said of the firms’ strategies globally.

In a recent interview with Frontier Myanmar magazine, BAT Myanmar managing director Rehan Baig denied that his company was using advertising in the country. SEATCA’s Myat Cho disputed this, saying that as well as selling and distributing cigarettes at teashops and restaurants, “they are also distributing complimentary napkins, ashtrays and lighters at teashops, and actually with the brands [visible]”. She added that cigarette kiosks often display promotion posters and some companies, she cited JTI in particular, were known to distribute free cigarettes at major religious festivals – both practices that are outlawed.

One of the more insidious, less-well-known avenues used by Big Tobacco to influence government policy is via the International Tax and Investment Centre (ITIC), which Mackay described as a “front organisation” for the alcohol, tobacco, oil and food industries that sets up secretive meetings with government officials worldwide to pressure them into keeping taxes low. She added that there is plenty of evidence the organisation is active in Myanmar.

“They have their meetings in the House of Lords in London; they’re a very, very powerful group of retired finance ministers and customs officials, and they’re using other front organisations and challenging governments. And when they get into a country, particularly, it seems to get even worse,” she said. “What they do is, they work with the ministry of finance, so the health people often… have no knowledge of them,” she added.

Despite this, Myat Cho is optimistic that the country’s new health minister, Myint Htwe, a former director of the non-communicable diseases department at the WHO’s regional office, will draw upon his experience to tackle tobacco use in Myanmar. Last year, the government increased taxes on tobacco products from 50% to 60%, and pictorial health warnings – shown to be effective in deterring smokers in other countries – are due to be introduced in September.

“The tobacco industry already wrote letters to the Ministry of Health to delay the implementation, so we’re expecting those challenges, but we’re working closely with the ministry and providing our assistance [with] whatever they need, so I think it will be effective,” she said. “And also the taxes on tobacco changed from ex-factory price to retail price, so the revenue will be increased, but whether it will be immediately effective on the reduction of smoking – they need to increase the tax higher.”

Regardless, in-country production, which makes cigarettes much cheaper and more accessible than foreign imports, is ramping up. At the height of military rule in the 1990s, approximately 500m sticks were produced in the country annually, according to official government statistics provided by SEATCA. This jumped to 3 billion by 2005, and it is estimated that 5 billion were manufactured last year. An increasing tide of production is difficult to stem, especially while the novice government has serious political, economic and social challenges it must now manage.

“The difficulty is that tobacco tends to be a rather low priority” in comparison to other issues, said Mackay. “The other difficulty is that, up to now, countries like Myanmar have been fighting infectious diseases such as TB, malaria and maternal mortality and infant mortality. They have no or very little experience dealing with the sophisticated tobacco companies; it’s a different paradigm, dealing with a vector that is not a mosquito, that is not a bacteria.”

The upshot, she added, is that a growing number of people in Myanmar are likely to take up cigarettes or swap their traditional tobacco for manufactured filter tips. “We’re certainly not talking within a year or two, but I would suspect if you were to review this in ten years’ time, you certainly might find a shift in the cigarettes people are smoking, particularly the young, and particularly the better educated; that would be the pattern.”

University student Kaung Htet Lin, 16, started smoking about a year ago amid peer pressure. Now, he struggles to kick the habit. “I want to quit, but I can’t because if someone smokes in front of me, I want to smoke and inhale too,” he said.

And in his changing preferences – from a local brand to one owned by tobacco giant BAT – could lie an early glimpse of the future: “Mostly I smoked Red Ruby; now I’m smoking Lucky Strike.”

Smoke gets in your eyes

The long, strange history of global tobacco use

Some smoke it, some chew it, others curse it. Regardless of its toxic health effects, tobacco has been a global pastime for centuries. Its origins are in the Americas, where the World Health Organisation (WHO) claims cultivation of the plant began as early as 6,000 BCE. Within 150 years of European settlers arriving to the ‘New World’, the tobacco plant was being used around the globe.

While in past centuries snuff and cigars were among the more popular methods of enjoying tobacco, the early 1900s ushered in mass cigarette production, and the modern cigarette was born in 1913 with R.J. Reynolds’ Camel brand. Smoking subsequently grew in popularity throughout the 20th century.

In 1951, however, the first large-scale study of the relationship between smoking and lung cancer was produced, followed by mounting evidence of the associated health risks. Smoking rates in industrial countries have dropped off significantly over the past 60 years, but tobacco use in the developing world remains a major health concern. The WHO predicts that tobacco use will cause 8.4 million deaths annually by 2020, 70% of which will occur in developing countries.

More Nonsmoking Teens Inhaling Flavored Nicotine Through Vaping

Jul 11th, 2016
by Editor.
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A study shows that many teenagers who would have never smoked are now vaping.Credit Katie Orlinsky for The New York Times

http://well.blogs.nytimes.com/2016/07/11/e-cigarettes-expand-teenage-nicotine-use-rather-than-replacing-it/?_r=1

Many teenagers who never would have smoked cigarettes are now “vaping” with flavored e-cigarettes, leading to a new generation using nicotine at rates not seen since the 1990s, a new study suggests.

The study, released Monday in the journal Pediatrics, tracked the use of cigarettes and e-cigarettes among 5,490 California high school seniors who graduated between 1995 and 2014. E-cigarettes do not burn tobacco, but are battery-operated inhalers that heat up and vaporize liquid containing flavors and nicotine, a practice known as vaping. The liquids used in vaping range in taste from traditional tobacco and menthol flavors to fruity and sweet combinations like gummi bear, banana bread and cotton candy.

When e-cigarettes came on the market in 2007, some public health experts hoped that they would serve as a substitute for traditional tobacco products and lead to declines in tobacco use.

But the data from the latest study, conducted by researchers at the University of Southern California, tell a different story. E-cigarettes do not appear to have made a dent in regular cigarette use — the number of high school seniors who reported smoking tobacco in the past 30 days has largely plateaued. In 2004, the number of 12th graders who reported smoking tobacco in the past 30 days was 9 percent; in 2014 that number was just under 8 percent.

But the rate of teenagers using nicotine — either through tobacco cigarettes or e-cigarettes — is on the rise. About 14 percent of Southern California high school seniors in 2014 said they had smoked or vaped in the last 30 days. Researchers say they have not seen similar levels of nicotine use among teenagers since 1995, when 12th-grade smoking rates were 19 percent.

The numbers suggest that rather than prompting teenagers to replace cigarette smoking with vaping, e-cigarettes instead have enticed an entirely new group of teenagers to use nicotine. While the study focused on California teenagers, researchers say the numbers are consistent with national trends.

“Kids are not just using e-cigarettes instead of cigarettes. That is what we were frankly hoping to find,” said Jessica Barrington-Trimis, the lead author of the study and a postdoctoral scholar research associate in the department of preventive medicine at the U.S.C. Keck School of Medicine. All of the teenagers that were expected to be using cigarettes in 2014 are using them, she said, “and then there is a whole group of kids using e-cigarettes on top of that.”

The amount of nicotine in the liquids used with e-cigarettes — often called “vape juice” — varies, and users can purchase liquid with no nicotine or nicotine content ranging from 3 milligrams per milliliter to 18 milligrams per milliliter or even higher. While earlier studies have suggested that some teens are using nicotine-free vaping liquids, researchers say the majority of teens appear to be using nicotine-infused liquid in their e-cigarettes.

Dr. Jonathan Winickoff, professor of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, who wrote an accompanying paper in Pediatrics, said this is the first study of e-cigarette use in adolescents to show such a strong longitudinal sample with such a drastic effect.

“We had a trend of decreasing nicotine use,” said Dr. Winickoff. “What the e-cigarette has done is halted that decrease in its tracks…. We don’t want a fifth of our high school students graduating with nicotine addiction.”

While e-cigarettes do appear to be safer than smoking tobacco, they are not risk free. Nicotine disrupts neurotransmitter activity and is highly addictive, particularly in a developing brain. And the liquids contain solvents, formaldehyde and other ingredients that pose health risks when inhaled.

While it’s true that there are nicotine-free vaping liquids, the e-cigarette industry is not regulated, which makes it hard to know what ingredients are actually in any given product. Though the Food and Drug Administration recently took jurisdiction over e-cigarettes, it will be years before any regulations are put into effect. Currently, many products continue to be made in China with little — if any — oversight by the United States.

“The F.D.A. has done tests on these vaping products that supposedly do and do not contain nicotine, and what is advertised is really not what’s in the product,” Dr. Winickoff said. “When the product is labeled as no nicotine, they’ve found nicotine. So kids don’t know what they’re getting, and as a pediatrician it really scares me.”

Not everyone agrees that e-cigarettes pose a significant risk to teenagers. Dr. Michael Siegel, professor of community health sciences at the Boston University School of Public Health, countered that many teenagers say they are using e-cigarettes that contain only flavorings and no nicotine, and therefore are not getting addicted.

“E-cigarette use among teenagers is a largely social phenomenon,” he said. “The fact that you tend to see teenagers doing this in groups, not out in the cold vaping alone, suggests that e-cigarettes are not addictive.”

But there is a growing body of research showing that e-cigarettes do serve as a gateway to traditional tobacco products. Last month, the U.S.C. researchers also reported in Pediatrics that adolescents who vape are six times more likely to smoke cigarettes in early adulthood as nonusers.

“Once kids get hooked on e-cigarettes, they are more likely to go on to become cigarette smokers,” said Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

Many Teens Who Wouldn’t Have Smoked Use E-Cigarettes

Jul 11th, 2016
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A new study concludes that the use of e-cigarettes may be more than making up for declines in teen smoking over the past decade.

http://www.healthline.com/health-news/teens-who-wouldnt-have-smoked-use-e-cigarettes#6

Cigarette smoking among teens has been on a steady decline since the mid-1990s.

But e-cigarettes could send all the gains made in reducing teen use of tobacco products up in a cloud of smoke — or make that vapor.

A new study suggests that many high school students who may have never smoked cigarettes are now using ecigarettes.

“A whole bunch of kids who probably wouldn’t have used anything are now being exposed to nicotine plus whatever other chemicals are in the e-cigarettes,” Jessica Barrington-Trimis, Ph.D., lead author of the study, and a postdoctoral scholar research associate in the Department of Preventive Medicine at the Keck School of Medicine of the University of Southern California, told Healthline.

Teens starting out on e-cigarettes

The study of 5,490 high school juniors and seniors shows that the use of tobacco products — specifically cigarettes and e-cigarettes — among teens in Southern California is on the rise.

In 2014, 13 percent of 12th graders surveyed said they had either smoked cigarettes or vaped in the previous month. About half of those students — almost 8 percent — were cigarette smokers, with some also using e-cigarettes.

E-cigarettes didn’t enter the U.S. market until 2007, so the researchers compared the 2014 combined level to levels of cigarette smoking, by itself, in earlier years. Levels were 9 percent in 2004, and 14 percent in 2001.

So while vaping is on the rise among teens, smoking is on the decline.

The researchers say, though, that the change in smoking levels from 2004 to 2014 is so small that statistically it’s more of a plateau.

Different smoking trends nationally

The study only looked at 12 schools in Southern California, so the results may not apply to all areas of the United States.

“Data from California is not comparable to the overall U.S. because the youth smoking trends in California are vastly different than in the rest of the nation,” Dr. Michael Siegel, M.P.H., a professor at Boston University School of Public Health, told Healthline in an email.

The Monitoring the Future Study, an annual survey of a total of 50,000 students in 8th, 10th, and 12th grades, supports the finding.

The national survey found much higher levels of cigarette smoking among high school students. Twenty-five percent had smoked during the month before the 2004 survey.

Thirteen percent said they’d smoked during the month before the 2014 survey.

Like the USC study, Monitoring the Future found that vaping levels in 2014 were higher than smoking. Seventeen percent of 12th graders had used an e-cigarette during the month before the survey.

Comparing the overall impact of cigarettes and e-cigarettes on the health of teens is difficult because these products are not identical.

Smoke from regular cigarettes contains more toxins and carcinogens that e-cigarette vapor.

The nicotine levels may also not be the same in the two products. Some liquids used in e-cigarettes contain no nicotine at all, only flavorings.

This may mean that a rise in e-cigarette use may be less harmful overall, at least in some ways.

“Nationally, overall nicotine use has remained about the same, but the profile of that use has changed,” said Siegel, “with a shift from combustible tobacco products to electronic.”

Smoke vs. vapor

That doesn’t mean e-cigarettes aren’t harmful.

Ingredients in the e-cigarette liquid vary among manufacturers, but can contain chemicals like the carcinogen formaldehyde. Inhaling vapor may also harm the lungs.

Plus, there is highly addictive nicotine in some e-cigarette liquids.

“Kids who are still in high school, their brains are still developing,” said Barrington-Trimis. “So use of nicotine products at that time is harmful, even if we’re just thinking about the nicotine.”

Some research also suggests that use of e-cigarettes may lead to cigarette smoking.

The continuing national decline in teen cigarette smoking, though, suggests that vaping may be keeping some teens from smoking.

For some experts, the increase in vaping may not be that concerning when you look at the big picture.

“This study does not change my overall assessment that nationally, the benefits from the huge observed decline in cigarette smoking among youth far outweigh the minor risks associated with youth vaping,” said Siegel.

Of course, the effect of vaping on your health depends on whether you are switching from smoking or starting fresh.

“E-cigarettes may be less harmful than cigarettes, but we don’t know a lot about what’s in them,” said Barrington-Trimis. “I think using ecigarettes is more dangerous than not using anything at all.”

E-Cigarettes May Be Getting More Kids to Smoke

Jul 11th, 2016
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Including teens who may have avoided tobacco products entirely.

http://fortune.com/2016/07/11/e-cigarettes-teen-use-growing/

Cigarette smoking among American teens is on the decline. But adolescents who may have never tried cigarettes are now vaping with e-cigarettes, new research suggests.

E-cigarettes’ popularity has soared in the past five years and ballooned into a $3.5 billion market. But while manufacturers claim that the products are healthier alternatives to traditional tobacco, public health officials have questioned their safety and pushed for regulations.

Much of the concern has centered on younger Americans who may be drawn to the high-tech smoking devices which often come with flavored nicotine. The Centers for Disease Control (CDC) recently found that an alarming 5.3% of middle school students and 16% of high school students reported using e-cigarettes in 2015—sharp rises from the figures reported at the beginning of the decade.

The new study by the American Academy of Pediatrics (AAP) tracked nearly 5,500 Southern California teens over the course of 20 years (1995-2014) and measured their smoking habits. In 2004, before vaping technology was around, 9% of 11th and 12th grade students were “current smokers,” meaning they’d smoked in the past 30 days.

Fast-forward to 2014 and 13.7% of those students currently smoke cigarettes or e-cigarettes. That sharp spike in the combined smoking data, the researchers wrote, “suggests that e-cigarettes are not merely substituting for cigarettes and indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products.”

Trends like these, as well as research showing that some vaping products contain high amounts of carcinogens like formaldehyde and acetaldehye, have spurred federal officials to crack down on the industry.

In May, the Food and Drug Administration (FDA) finalized new regulations treating e-cigarettes, hookah, and cigars like traditional cigarettes. That means that any e-cigarette manufacturer whose products weren’t already on the market by February 15, 2007 will have to seek marketing approval from the FDA. They’ll also have to put labels on the devices’ packaging warning about nicotine’s addictive properties, and states will be strictly prohibited from allowing e-cigarette sales to minors (a practice that was previously permitted in several places).

But the rules have drawn sharp rebukes from the industry. Smaller e-cigarette manufacturers say that the types of studies required to pass the FDA’s regulatory muster will favor Big Tobacco companies like Imperial Tobacco and Reynolds American, which also make popular vaping brands like blu and VUSE.

A final resolution over the rules, as The Hill notes, may be determined in the courts. A compendium of e-cigarette companies and trade organizations including Nicopure Labs, the American Vaping Association, and the Right to be Smoke-Free Coalition, among others, have recently filed complaints against the FDA and the Department of Health and Human Services (HHS) calling the regulations “unreasonable” since vaping products contain just nicotine and not tobacco.

Teens Are Vaping Themselves Into Nicotine Addiction

Jul 11th, 2016
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Teens: can’t trust them to do anything right. First it was hoverboards, then it was following in Justin Bieber’s teenage dirtbag footsteps, and now it seems that modern-day teens, who might not otherwise have been susceptible to nicotine addiction, are vaping themselves silly.

A new study published Monday in the journal Pediatrics found that teens are still ingesting nicotine at a higher rate than experts expected. The study tracked “the use of cigarettes and e-cigarettes among 5,490 California high school seniors who graduated between 1995 and 2014″ and found that because of vaping, teens report inhaling nicotine at rates researchers haven’t seen since the ’90s. Remember how much people smoked in the ’90s? From the Times:

But the rate of teenagers using nicotine — either through tobacco cigarettes or ecigarettes — is on the rise. About 14 percent of Southern California high school seniors in 2014 said they had smoked or vaped in the last 30 days. Researchers say they have not seen similar levels of nicotine use among teenagers since 1995, when 12th-grade smoking rates were 19 percent.

Teens who wouldn’t have otherwise smoked cigarettes are instead getting nicotine by vaping, the study found, and “while earlier studies have suggested that some teens are using nicotine-free vaping liquids,” researchers said that most teens appear to use vape juice infused with nicotine.

A professor of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, Dr. Jonathan Wickoff, told the New York Times that the dangers of nicotine addiction are still very real, even in vaping: “The F.D.A. has done tests on these vaping products that supposedly do and do not contain nicotine, and what is advertised is really not what’s in the product.” Get it together, teens. The vape life isn’t for you.

Doctors should NOT recommend ecigarettes to smokers – existing treatments are more effective and safer, experts say

Jul 11th, 2016
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  • Existing smoking cessation therapies are ‘more effective than e-cigarettes’
  • New commentary warns of ‘no strong evidence’ e-cigarettes are safe
  • Warn doctors should not be recommending the devices to their patients

E-cigarettes should not be recommended to smokers who are trying to quit their habit, experts today said.

Existing treatments are more effective than the devices in helping people stub out their cigarettes, and there is no strong evidence that e-cigarettes are safe, new research suggests.

The health benefits of quitting smoking are widely accepted.

But, researchers at the University of North Carolina at Chapel Hill have taken issue with the suggestion that doctors should routinely recommend e-cigarettes as an alternative.

In a commentary published in today’s Annals of Family Medicine, they say there are professional ethical concerns about doctors who do recommend the devices – warning there is no evidence they are safe.

Professor at the UNC School of Medicine, Adam Goldstein, said: ‘Providers should not routinely recommend e-cigarettes to patients until we have far more data on their safety and effectiveness compared to established, FDA-approved medications.

‘There are very few therapeutic devices that we recommend that aren’t regulated, that have potential and real side effects, and that are addictive.

‘There are safer and more effective smoking cessation products for the same condition.’

The researchers warned of notable safety and health concerns linked to e-cigarettes.

Batteries inside the devices have caught fire or exploded, and particulate matter from e-cigarettes, which has been shown to be present in similar numbers to cigarettes, can increase the risk of cardiovascular and respiratory diseases.

The new commentary served as a counterpoint to a paper in the same journal issue by Professor of tobacco addiction, Ann McNeill, at King’s College London, that suggests e-cigarettes are a less harmful way for smokers, including those trying to quit, to use nicotine.

‘Though e-cigarettes are likely not as harmful as conventional cigarettes, a growing number of studies report that they are by no means harmless,’ said Clare Meernik, MPH, a research specialist in the UNC Department of Family Medicine.

‘Short-term effects include exposure to toxins, reduced respiratory and lung function and burn related injuries from exploding devices.’

The researchers also noted that e-cigarettes have been less effective than existing treatments to help people quit smoking.

‘People are focused on should they use ecigarettes or not. We can have a conversation about that, but part of the bigger picture is being lost,’ Professor Goldstein said.

‘And that is that we need be using the tools that we currently have available, including seven FDA-approved medications in combination with behavioral treatment.

‘We have quit lines that provide free counseling and physician counseling to help patients come up with concrete plans for quitting and developing the skills necessary to quit permanently and to increase social support – all of which significantly increase cessation.’

In May the U.S. Food and Drug Administration announced it was extending its authority over all tobacco products, including e-cigarettes.

Greater regulatory oversight of e-cigarettes, the researchers said, will be a significant step forward toward ensuring higher safety standards.

‘We need more data on effectiveness, we need more data on safety, we need technology that’s safe so the products don’t explode, we need to ensure they’re childproof,’ Professor Goldstein said.